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Debbie Dent, 51, lost her front tooth when her abusive boyfriend punched her. Now that she's had her smile restored by the Give Back a Smile program, she has more confidence and is looking for a new job.

Debbie Dent escaped an abusive relationship more than a decade ago. But every time she looked in the mirror, her missing front tooth reminded her of the fear, pain -- and shame.

Dent’s boyfriend punched her face so badly in 1995 that she could barely breathe. Emergency room doctors patched her up, but they also had to remove a front tooth that broke off at the root, causing extreme sensitivity, making it impossible for her to close her mouth comfortably.

“All I could see was a monster when I looked in the mirror,” says Dent, 51, who works in the service industry in Chicago. “It’s hard to move forward when you’re constantly reminded that you were a victim.”

Her boyfriend went to jail for several years, but when he was released, he convinced Dent that he still loved her and that he had changed. Dent says she felt ugly and alone, so allowed him back into her life. The hitting began again, and when Dent left this time, he tracked her down and beat her right eye in so badly, it had to be surgically removed.

Doctors replaced her missing eye with a prosthetic. But she would have to pay out-of-pocket for dental work, and that cost was well beyond her means. So for 15 years, Dent covered her mouth when she talked to people she didn’t know. Certain words were tough to pronounce. She rarely smiled.

About 75 percent of all physical domestic violence results in injuries to the head, neck, and mouth. It is also the leading cause of avulsed, or knocked out, teeth, among women over age 21.

But restorative dental work is pricey, so for many victims, fixing a broken smile is a financial impossibility.

Last year, Dent was chosen to participate in the Give Back a Smile program, sponsored by the American Academy of Cosmetic Dentistry Charitable Foundation, based in Madison, Wis. The program provides free care to abuse survivors with broken or damaged teeth.

Dent, received nearly $6,000 worth of dental care, which included a bridge and bonding to repair two other fractured teeth.

So far, Give Back a Smile has provided care to more than 1,000 domestic abuse survivors. “We don’t cut any corners when it comes to restoring their smiles,” says cosmetic dentist Kenneth Banks, board chairman of the program.

On average, the dental work performed on the abuse survivors costs about $9,000 or more, with lab technicians and 600 dentists across the U.S. and Canada providing their services. “There’s a strong emotional tie between a smile and self-esteem,” says Banks, who practices in Inwood, W. Va. “These patients have been through hell, and this is something that we can do to help them get their confidence back.”

Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

Losing a tooth changes not only self-perception, but also how you are seen by others. A study published in the journal Perceptual and Motor Skills looked at how people view the dental-challenged. Some 200 study participants looked at photos of individuals with full smiles as well as those missing front teeth and then rated them on traits like health status, intelligence, educational attainment, trustworthiness, and aggressiveness, among others. Those with missing teeth were more negatively perceived on all counts.

Domestic violence counselors say that’s an all-too-common scenario. Abuse victims who lose teeth often suffer from isolation, which “... is exactly what an abuser wants,” says Katie Ray-Jones, president of the National Domestic Violence Hotline and National Dating Abuse Helpline. “It’s about control, and let’s face it, it’s hard to find a job even in good economic conditions, when you’re missing teeth.”

Dent was laid off from her job as a dishwasher this past August. She has an interview this week in the food services industry, one with more responsibility and better pay. She hopes her new smile will help her close the deal.